Ask anyone who suffers from chronic back pain what the experience is like, and they’ll tell you the same thing: It’s life-altering. Former What Not to Wear star Stacy London just revealed in an honest essay that she was one of them—and she experienced clinical depression after undergoing surgery to correct her pain.

In the essay for Refinery29, London says that she decided to have her surgery in December 2016 after struggling with back pain for four years. Her surgery wasn’t a secret—she documented several parts of it on Instagram, including a photo of titanium screws in her back.

But what London didn’t talk about at the time was the emotional side of her surgery, and she now says the aftermath left her “broken.”

“The truth is, I didn’t understand the extent to which back surgery would cripple me—emotionally and physically,” the 48-year-old wrote. “The time in the hospital alone included some of the most agonizing moments I’ve ever had.”

London says she was “foggy” post-op thanks to the pain meds she was on, but even after she went off the medication she was in severe pain. She wasn’t working at the time, which took away her schedule and made her feel like she she didn't have a purpose. Even though she wasn’t working, London says she started spending a lot of money on things like expensive clothes and food delivery twice a day to try to pretend like she wasn’t in pain.

Then, just over eight weeks after surgery, she started to experience anxiety and depression. “I started to feel…well, weird,” London wrote. “Paranoid in a way I’ve never experienced before. I didn’t want to go outside because my anxiety of slipping or someone bumping into me was too much to bear."

She writes that she was so anxious that she had trouble sleeping. And she experienced uncontrollable "fits of crying." As it turns out, she writes, "what I had been feeling was clinical depression (who knew?), which I later discovered is quite common with surgeries involving the spine, brain, and heart. The body is traumatized on a deep, subconscious level."

Unfortunately, it’s not unheard of for someone to become depressed after having surgery—especially spinal surgery.

According to the American Psychological Association, depression is a complex disorder that often stems from a combination of biology, genetic risk factors, personality, and environmental stressors, such as abuse, losing a loved one, or, possibly, major surgery.

“Any type of surgery is a potential risk factor for developing depression or exacerbating symptoms in someone with a history of depression,” Simon Rego, Psy.D., chief psychologist at Montefiore Medical Center/Albert Einstein College of Medicine, tells SELF.

And it makes sense. You're putting your body—and your emotions—through a lot all at once. “Anything that is a physical or psychosocial stressor can increase your risk of depression—and major surgery can be both,” James Murrough, M.D., director of the Mood and Anxiety Disorders Program at Icahn School of Medicine at Mount Sinai, agrees.

According to a study published in January 2017 in Mayo Clinic Proceedings, people who undergo spinal surgery are at a higher risk for developing depression than those who have other types of surgeries that may be associated with depression. Researchers looked at records for over a million patients who had surgery in California between 1995 and 2010, and they found that the risk for developing new depression was higher after spinal surgery than it was after gallbladder removals, hysterectomies, and treatment for congestive heart failure or chronic obstructive pulmonary disease.

If someone was previously active before their surgery and then are limited in what they can do post-op, it could trigger depression, Dr. Rego says. Post-op pain can also be a factor, as well as physical and emotional stress from undergoing surgery, Dr. Murrough says.

People who have chronic back pain may already be at risk for depression before they have surgery, which increases the risk that they'll experience depression afterward.

"I can certainly attest to seeing a number of patients who bring overwhelming depression and chronic pain into my office when they first visit and even after surgery," Neel Anand, M.D., professor of orthopedic surgery and director of spine trauma at Cedars-Sinai Spine Center in Los Angeles, tells SELF. "Unfortunately, when depression enters into the mix of other symptoms that accompany a spinal disorder, it can become a vicious cycle. Depression can make the feeling and intensity of back pain worse and the elevated pain can deepen the depression."

Dr. Anand says it's important for him to help his patients understand that depression is common when someone is dealing with chronic pain. "Of course, that doesn’t make these symptoms OK and it certainly doesn’t mean that any of it should just be 'lived with,'" he says. "It’s just important for people under these circumstances to feel like they’re not alone."

It’s impossible to really know ahead of time how you’ll feel after surgery, but there are a few things you can do to protect your mental health.

The first is recognizing that it’s completely normal that you might feel a bit "off" emotionally after surgery, Dr. Rego says. “Don’t be surprised if you have these feelings, even if you don’t have a history of depression,” he says. So, if your surgery is scheduled, it’s a good idea to practice what Dr. Murrough calls “good mental hygiene” before going under the knife. That can include regular physical activity, staying in touch with friends, and a balanced diet.

After surgery, know that you're going to have to let yourself chill for a while. "While your body is healing, especially in the early days after surgery, it needs plenty of rest," Dr. Anand says. "Rest is an integral part of the healing process, even if it seems like a passive activity to you." However, many patients are up and walking after spinal surgery while they're still in the hospital, Dr. Anand says—they just need to be careful not to overextend themselves (this can cause damage to the spine).

If you’re struggling with being laid up after surgery, Dr. Rego recommends trying to accept that you may have temporary limitations, but that they’ll get better, and focusing on what you can do versus what you can’t. For example, even though you may not be able to go the gym like you normally would, you can try to go for a walk around your block—and that’s still something. It’s also a good idea to regularly check in with your doctor about how you’re feeling and what you can be doing to move the recovery process forward, he says.

But, if you find that your symptoms continue for at least two weeks or they're getting worse, that's a signal that you're dealing with something serious. The good news is that it gets better, especially with professional help. “Depression triggered by surgery is treated just as effectively as depression that’s not triggered by surgery,” Dr. Rego says, and treatment usually includes some combination of therapy and/or medication. (If you’re still struggling but aren’t very mobile, teletherapy or mobile therapy with a licensed mental health professional may be beneficial.)

London admits that she’s not sure that 2018 will be better than last year, but she’s hopeful. “Everyone keeps telling me not to worry. How could things get worse? I honestly don’t want to know the answer to that," she writes. "What I want now is some glue. And hope is very sticky, indeed.”